Transcript E-Prescribing and the Prescription Drug Program

E-Prescribing and the
Medicare Prescription
Drug Program
Maria A. Friedman, DBA
Health Strategies LLC
Formerly Senior Advisor, Centers for
Medicare and Medicaid Services
July 2006
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E-Prescribing under the MMA
 MMA creates an ambulatory electronic
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prescribing program under Part D
Voluntary for physicians and pharmacies
Part D plans must support e-prescribing, should
their physicians and pharmacies desire to do it
If e-prescribing is done, must use standards
promulgated now and in the future
Only includes non-controlled substances. DEA
has not yet issued requirements for eprescribing of controlled substances.
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DEA/HHS public meeting held 7-11/12/06 to begin
input to the process
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MMA E-Prescribing Timeline
 Announcement of Initial Standards -
September 2005
 Pilot begins - January 2006
 Part D goes live - January 2006
 Pilot conclude December 31, 2006
 Report to Congress on Pilot - April 2007
 Additional Standards Final Rule - April 2008
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How E-Prescribing Standards
are Developed under MMA
 Initial standards must be tested through pilot
project during CY 06
 EXCEPTION – Pilot testing not required where
there is “adequate industry experience”
 NPRM proposed foundation standards where
adequate industry experience exists
 Three foundation standards with adequate
industry experience adopted in final rule,
published on November 7, 2005
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Three Adopted
Foundation Standards
 NCPDP SCRIPT standard, Version 5, Release
0 (except for the Prescription Fill Status
Notification Transaction)
For transactions between prescribers and
dispensers for:
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New prescriptions
Prescription refill requests and response
Prescription change request and response
Prescription cancellation request and response
Ancillary messaging and administrative
transactions
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Three Adopted Foundation
Standards (cont)
 ASC X12N 270/271, Version 4010 and
Addenda –
For eligibility and benefits inquiries and
responses between prescribers and Part
D sponsors
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Three Adopted Foundation
Standards (cont)
 NCPDP Telecommunications Standard,
Version 5.1 (and the equivalent Batch
Standard, Version 1.1)
For eligibility and benefits inquiries and
responses between dispensers and Part
D sponsors
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NCPDP SCRIPT 8.1
Voluntary adoption of NCPDP SCRIPT 8.1
(Federal Register 6/23/06)
Version 5.0 is official standard. Version 8.1 is
backward compatible and may be used by
agreeing parties. Trading partners may not be
coerced to use 8.1.
Version 8.1 is important because it contains the
medication history standard
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Exemptions
 Computer-generated faxes
 LTC facilities
 Internal messaging for staff model HMOs
and other closed systems
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BUT—they must be able to convert their
messages to NCPDP SCRIPT if they are
sending them “outside” to a non-network
pharmacy
Also must accept prescriptions sent using
NCPDP from outside
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Pilot testing E-rx Standards
 MMA requires pilot testing of standards
for which there is not adequate industry
experience
 Voluntary participation via agreements
with the Secretary
 Conducted during Calendar Year 2006
 Pilot testing results will be used to
develop final e-prescribing standards to
be adopted in 2008
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What Additional Standards
Will be Pilot Tested
 In addition to the three foundation standards, the
pilots will test:
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Formulary and benefit information - NCPDP standard
using RxHub protocol
Exchange of medication history –NCPDP standard
medication history message using RxHub protocol
Structured and Codified Sig – Test structured and
codified SIGs (patient instructions) developed
through standards development organization efforts
Clinical drug terminology – Determine whether
RxNorm terminology translates to NDC for new
prescriptions, renewals and changes
Prior authorization messages - New version of ANSI
ASC X12 278
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Additional Considerations for
Pilots
 Focus of pilots is testing of standards to see if they
work well together, are interoperable, and
information is correctly sent and received
 If possible, proposals also asked to address
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Structured product label
LTC settings
Disadvantaged populations (including 25% Medicare
beneficiaries in study)
Impact on quality of care (eg, reduction of adverse
drug events and medication errors; improved patient
compliance)
Impact on physician ROI (eg, reduced callbacks to
pharmacy)
Reasons for adoption/retention and barriers
Cost savings (eg, through improved formulary use)
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Pilot Testing Timeline
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Projects to be competitively awarded
Cooperative agreements
CMS collaborating with AHRQ
RFA on the street on 9.15.2005
16 proposals were received; 14 were
sent to an AHRQ-convened review panel
 12 proposals reviewed, which met on
12.1. 2005
 Awards were made in late December
2005
 Evaluation contract awarded by AHRQ
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Awardees, based on results of
12-1-05 review
 Applications underwent rigorous review by
review panel that consisted of national experts in
pharmacy, e-prescribing, health IT
 Five awardees emerged, based on scores
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RAND
Brigham and Women’s
SureScripts
LTC study in MN
Ohio KePRO
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MMA E-Rx Pilots
RAND
NJ e-Prescribing Action Coalition, including
RAND, Horizon, Caremark (PBM, mail,
iScribe), Allscripts, RxHub, SureScripts,
UMDNJ and Point-of-Care Partners
SureScripts
SureScripts, Brown University,
Allscripts, DrFirst, Gold Standard,
MedPlus/Quest Diagnostics, ZixCorp,
pharmacies in FL, MA, NV, NJ, TN and RI
Achieve Healthcare (Long-term Care)
Benedictine Health System, Preferred
Choice Pharmacy, RxHub, Prime
Therapeutics, BCBSMN
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MMA E-rx Pilots (cont’d)
Brigham & Women’s (Massachusetts)
 B&W Hospital, Partners Healthcare,
MA-Share, CSC, BCBSMA, RxHub,
SureScripts
Ohio KePRO-UPCP
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University Primary Care & Specialty
Physicians (UPCP), Ohio KePRO, InstantDx,
NDC Health, RxHub, SureScripts, Qualchoice,
Aetna, MGMA Center for Research and the
University of Minnesota
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MMA E-rx Pilots (cont’d)
High-level Observations
 Comprehensive, with 5 very different
approaches
 SureScripts, RxHub involved in 4 of 5
pilots, each
 Value added beyond standards testing
 Measuring ADEs, changes in response
to formulary and allergy alerts
 Very cooperative environment
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QUESTIONS?
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